MINOR CREDIT SEMINAR
Dr. Adhiraj Mishra, M.V.Sc (1st Year), Div. of Epidemiology
Dr. DK Singh, Principal Scientist, Veterinary Public Health
Dr. Bhoj R Singh, Principal Scientist and Head, Division of Epidemiology
MAGNITUDE OF GLOBAL TRAVEL
International arrivals will
reach 1.6 billion by 2020.
International Tourist (million)
Travel to developing
countries increased from
31 % to 47% and to Asia
Pacific and Middle East
have doubled in last
REASON OF TRAVEL
International Travel & Health, 2012
TRAVEL RELATED RISK factors
Mode of transport.
Duration and season of travel.
Purpose of travel.
Behaviour of the travellers.
Underlying health of the travellers.
AIR TRAVEL & Associated Risks
Quality of Aircraft cabin
air & HEPA Filter.
Auxiliary Air Unit.
Coughing, sneezing and
direct or indirect contact.
e.g-TB, Influenza, SARS
SEA TRAVEL & Associated Risks
13 million passengers travel worldwide on cruise ship.
Disease transmission through: Contaminated food &
Water, Whirlpool spa, inhalation. e.g. Gastroenteritis
(2006), Influenza & other RTI, Legionellosis (1994)
(International Travel & Health, 2012)
DISEASE DIAGNOSIS BY GEOSENTINEL SITES
Cutaneous Larva migrans
Rabies P E Prophylaxis
Acute Hepatitis A
Confirmed Influenza A/B
Leader K, Torresi J et al, 2013
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
Zoonotic viral disease caused by the SARS-CoV.
By July 2003, 8,273 cases and 775 deaths reported in
multiple countries (9.6% fatality rate). Within weeks, SARS
spread from Hong Kong to 37 countries in early 2003.
1st seen- Guangdong Province of China-16th Nov, 2002
Dr. Liu Jianlun reached Hong Kong-21st Feb, 2003
Stayed in Metropole Hotel Room No.911 and shifted to
Hospital on 22nd Feb 2003 and died on 4th March
American businessman who stayed
in the same hotel, now travelling
from China to Singapore had
emergency landing in Vietnam and
Canada, Singapore, China, Vietnam
, United States, Mongolia etc.
WHO issued global alert on 12th
1st case in India- 32 year man in
Goa, who returned from Hong
Kong and Singapore on 17th April
PANDEMIC INFLUNZA (H1N1)
“pH1N1", 1st identified in April 2009, and
initially spread in Mexico and then
Emerged from pigs in Asia, and was
carried to North America by infected
The first case of the Swine flu in India -on
13 May 2009, when a 23 year old man
travelling by Emirates Airline from New
York to Hyderabad via Dubai.
AVIAN INFLUNZA (H5N1)
Avian influenza A (H5N1), first seen in Hong Kong in
1997. Then, it reappeared in Vietnam in 2003 and has
been in continuous circulation ever since.
H5N1 has primarily affected poultry, from 2003
through 2011, 578 human illnesses in 15 countries were
reported, with an alarming case-fatality ratio of 59%.
The countries with the most cases of human disease
(Indonesia, Vietnam, and Egypt) account for 80% of
all cases and 78% of all deaths.
(Ostroff SM, 2012)
AVIAN INFLUENZA IN CHINA
Avian influenza A (H7N9) virus was first reported in
China among human beings and poultry.
Till 6th Nov, 2o13, 139 H7N9 human infections were
reported & 45 people died. (ProMED-Mail).
Person-to-person spread of H7N9 is rare.
PREVENTION OF RESPIRATORY
Frequent washing of hands with
soap & water.
Wear disposable gloves and
apron and N-95 mask.
Eye protection (e.g. face shield or
goggles) if splash or spray of
body fluids is likely.
Thermal Screening at airport &
HIV/AIDS and Travel
HIV-I pandemic started by
mid 70s and 80s spread to
five continents through air
travel, sea travel and human
Case of ‘Patient Zero’, a
Canadian flight attendant
who travelled extensively
In the United States, the
rapid spread of AIDS
between 1984 and 1990 can
be modelled accurately
using air traffic flows
(CDC, Yellow Book 2012)
MRSA, Strains of N. gonorrhoeae & multidrug resistant
(Ostroff SM, 2012)
Travel of NDM-1
First detected in patient’s stool
who returned to Sweeden after
hospitalisation in India in Jan
A total of 37 isolates with
NDM-1 were recovered from
50 UK patients and 143 from
Since Aug 2010, it has
worldwide distribution except
in Central and South America.
GLOBAL SPREAD OF NDM (June2012)
Ostroff SM, 2012
In 2000, Dengue spread to the US
via infected travellers.
Caribbean Sub Saharan
Cases of Dengue among travellers (Leader K, Torresi J et al 2013)
Restricted to Africa & Asia
and after the Kenya
outbreak in 2004 it
appeared in islands of
Indian Ocean in 2005 and
Subcontinent in 2006.
Travellers to India and
Indian visitors then spread
it to Europe, North
America and Australia
having viable vectors.
WEST NILE VIRUS
The West Nile Virus is
believed to reach United
States in 1999 via mosquitoes
that crossed oceans by aircraft
(CDC Yellow Book 2012)
HAJJ PILIGRIMAGE & DISEASES
Yellow Fever-Risk area
(Weekly Epid. Report, 2013)
Spread of Emerging Diseases
Corona virus first reported on
24th Sept, 2012 in Saudi Arabia.
As on 19th Nov, 2013 157 people
‘Sacrifice Voucher’ can spread
Meat borne Zoonoses.
Blood Borne Pathogen like
Heaptitis B, C and HIV.
(Balaban V, Ahmed, Q, 2011)
100 million people, 600 km pipes, 92 million litres clean
water/day, 35,000 temporary toilets and 10,000 night soil
( Balsari S, 2013)
London Olympic 2012:
15,000 athletes, 70,000
FIFA World Cup 2010:
32 national teams & 3.2
World Cup Cricket, 2007
16 participating nations
and 1 million spectators.
FOOD AND WATER PRECAUTIONS
Selection of foods
well-cooked and hot.
salads, raw vegetables, raw or
undercooked eggs and meat.
unpasteurized dairy products
Insect repellent containing DEET 25 – 50%
Treatment of outer clothing with
permethrin or etofenprox.
Use of permethrin-impregnated bed net
Use of insect screens over open windows
Air conditioned rooms
Use of aerosol insecticide indoors
Use of pyrethroid coils outdoors
BLOODBORNE DISEASES & STD PRECAUTIONS
Unprotected sexual activity
Commercial sex workers
Tattooing and body piercing
Dental and surgical procedures
INTERNATIONAL HEALTH REGULATIONS, 2005
Came into force on 15th June 2007.
Their main objectives are to ensure:
(1) Routine, preventive measures (e.g. at ports and airports)
and the use by all countries of internationally approved
documents (e.g. vaccination certificates);
(2)The notification to WHO of all events that may constitute
a public health emergency of international concern; and
(3) The implementation of any temporary recommendations
should the WHO Director-General have determined that
such an emergency is occurring.
(International travel & health, 2012)
WHAT TO DO?
Pre-travel Medical Consultation.
Strengthening of travel industry.
Redefine responsibility of the travellers.
Introduction of Travel Health & Mass Gathering Health in
Public Health Curriculum.
Medical Insurance of travellers.